Workers Comp FAQ’s & Answers

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Georgia Workers’ Compensation FAQ’s

Who is Eligible to Receive Workers’ Compensation Benefits? What Benefits can an Injured Employee Receive? What Should I do if My Claim is Denied?

Every year, thousands of Georgia employees are injured on the job. Fortunately, because the state requires almost all employers to purchase workers’ compensation insurance, employees who are hurt on the job are usually eligible to collect benefits.

Workers’ compensation benefits can play a crucial role in helping injured employees get back on their feet, so it is especially important for Georgia workers to be familiar with the state’s workers’ compensation laws. We’ve included a few FAQs to help get you started, but if you are looking for more in-depth information or advice, you should consider speaking with an experienced workers’ compensation lawyer who can address your questions and concerns.

1. Will workers’ comp apply if I got injured on my first day on the job?

Yes. If you are hurt at work no matter how long you have been employed, workers’ comp should apply.  There are other considerations that would necessitate a call to Spillers Law to confirm the future dynamics of your claim.

2. What should I do if I get injured at work?

You should immediately report your accident and injury to your supervisor (and to your human resources director or safety manager) and request appropriate medical attention.  The more people you promptly notify, the chances are less that the employer and insurer will deny your claim. 

3. Can I go to my own doctor?

No.  You should seek treatment with one of the employer’s panel of physicians.  The names of available doctors are listed on a pink sheet of paper, which is generally located in the break room or office.  If you do not see a panel of physicians, you should contact Spillers Law to discuss your options for treatment and they will assist you in selecting a doctor. 

4. Who pays for my medical treatment?

As long as you treat with an authorized physician, the employer and insurer will pay for all reasonable and necessary medical treatment.  If you seek unauthorized medical treatment, the employer and insurer would not be responsible and you would have to pay for that treatment.

5. What happens if I am not able to work after my accident?

If you are taken out of work by an authorized treating physician for seven (7) consecutive days, then you would be entitled to workers’ comp checks for all days that the authorized doctor keeps you out of work thereafter.

6. What if I don’t like the company doctor?

If your employer had a panel of physicians, you are entitled to change doctors one time to another physician on the panel.  Any additional requests to change physicians would have to be done by Motion to the State Board of Workers’ Compensation.  The attorneys at Spillers Law can help you with changing doctors.

7. How much money will I get paid if I’m out of work due to my work injury?

Income benefits are determined by calculating two-thirds of your average weekly wage for the thirteen (13) weeks preceding your accident.  For example, if your gross income was $500 for 13 weeks before your accident, your comp rate would be $333.33.

8. How long will I receive medical treatment?

Unless your injury is catastrophic, the maximum period of time to receive medical treatment is 400 weeks from the date of accident.  You are entitled to medical treatment as long as it is causally related to the work accident and is reasonable and necessary.

9. Can I get a second opinion with another doctor?

Yes.  Within 120 days of your receipt of any income benefits, you are entitled to a second opinion (called an independent medical examination) by a doctor of your choice and at the expense of the employer and insurer.  If it has been more than 120 days since you last received income benefits or if you have never been paid income benefits, you would be responsible for the payment of a second opinion.

10. What type of injuries are covered by workers’ comp?

Any type of injury so long as it arose out of an in the course and scope of your employment.  Some examples of the types of injuries we frequently see are:  back, neck, hip, shoulder, elbow, wrist, hand, knee, ankle, foot, eye, and ear.  More specific injuries include carpal tunnel, rotator cuff, herniated discs, meniscus tears, amputations, chronic pain, burns, and brain injuries, as well as psychological injuries.

11. Should I get a lawyer?

Absolutely!  No matter how nice you think the insurance adjuster is treating you, you must remember that he or she is an advocate of the employer and insurer only!  You need an attorney, who specializes in workers’ comp to represent you and protect your rights.  You should immediately contact Spillers Law where two of the most respected Georgia workers’ comp attorneys practice with more than 50+ years’ workers’ comp experience.

12. Does it matter where my attorney is located if I live hours away from metro Atlanta? 

No.  At Spillers Law, we are happy to represent any injured worker in the state of Georgia.  The best advice is to hire an attorney that you trust, respect, and know will do the very best on your case.  At Spillers Law, the attorneys meet with all clients and are the ones handling every step of your claim. 

13. I want my day in court.  Can I take my workers’ comp case to a jury?

No.  In Georgia, workers’ comp cases administrative proceedings and are heard by an administrative law judge only.  There is no jury nor can you file a workers’ comp claim in any other Georgia court. 

14. What should I do if my workers’ comp claim is denied?

First, you should call Spillers Law to discuss the facts of your claim.  You should definitely hire an attorney.  Otherwise, you may find yourself missing deadlines and/or being barred by the statute of limitations.

15. What should I do if I was working as an undocumented immigrant at the time I was injured?

You should immediately report the accident and call Spillers Law for continued guidance in your claim.  You are still entitled to workers’ comp benefits. 

16. Can the judge order a settlement if I don’t want to work for my employer any longer and I don’t want medical treatment?

No.  The judge does not have legal authority to award a lump sum settlement in workers’ comp cases.  All settlements are voluntary.  Neither parties can be forced to settle a Georgia workers’ compensation claim.

17. Can my employer make me go to a doctor that is hours away from my home and my employer?

Yes.  The employer and insurer may schedule appointments for medical treatment at reasonable times and places.  However, at Spillers Law, we would not just automatically tell you to go to long distance appointments.  There are occasions when the employer and insurer will negotiate a different physician.  Regardless of where you travel, you will be reimbursed at the rate of 40 cents per mile for your mileage to and from all appointments for medical treatment.

18. Who provides transportation to my doctor’s appointments if I don’t have a car?

The employer and insurer decide how to provide transportation based upon location, accessibility to transportation providers, costs, etc.  In some cases, a Breeze card is provided, and in other cases, private transportation is used.  There is no set rule for how transportation must be provided.

19. How will I talk to the doctor if I do not speak English?

Once the employer and insurer are aware of the communication barrier, it is very common for an interpreter to be provided to attend all of your medical appointments.  However, if your claim is denied, you may be responsible for getting a bi-lingual friend or family member to attend with you.  Spillers Law may be able to assist in finding an interpreter for you.

20. What do I do if the insurance company has someone following me?

You should always follow the work restrictions given to you by your doctor no matter where you are.  The insurance company routinely hires private investigators to watch your activities at your home, work, church, or anywhere you may go in an effort to find you performing activities outside of your work restrictions.  If they are successful in obtaining surveillance of you engaged in such activities, your workers’ comp claim may be compromised.

21. Will my employer owe me my regular pay if I keep working at light duty?

No.  The employer may choose to continue your regular pay, but that is their choice.  If they decide to pay less than your regular pay, you may be entitled to temporary partial disability benefits to make up some of the difference.  Spillers Law can assist you with making sure you are receiving the correct amount of income benefits.

22. Will you be handling my case directly?

At Spillers Law, the attorneys are completely hands on.  Of course, some activities are performed by staff, but attorneys meet with all clients at any time needed or requested and attend all depositions, mediations, and hearings.  Attorneys communicate with all parties no matter the subject.  You can rest assured knowing that your case is a priority.

23. What if my workers’ comp checks are late?

Call Spillers Law to handle the issue.  You may be entitled to a 15% penalty.

24. Will I get paid pain and suffering in my workers’ comp case?

Despite the time, agony, and pain, you unfortunately do not get paid anything for pain and suffering in Georgia workers’ comp claims.  It can not be ordered or awarded by a judge either. 

25. Do I have to allow the nurse case manager to attend my medical appointments with me?

No.  You are not required to consent to allow the nurse case manager to attend your private examination with the doctor.

Who is Eligible to Receive Workers’ Compensation Benefits?

Employers with three or more employees are required to purchase workers’ compensation insurance, so most employees across the state are eligible to receive benefits. As long as an injured worker was not intoxicated, under the influence of drugs, or participating in an illegal activity at the time of the workplace accident, his or her injuries will most likely be covered.

Are Independent Contractors Covered by Workers’ Compensation?

Unfortunately, independent contractors are not entitled to benefits under Georgia’s workers’ compensation laws. However, it can be difficult to determine whether a person qualifies as an employee or an independent contractor, so courts apply a series of factors when making these decisions, including:

  • Whether the employee signed an independent contractor agreement;
  • Whether the injured worker is paid on an hourly basis or is compensated at the completion of a job;
  • Whether the injured worker’s job is considered a part of the employer’s regular business or is viewed as an additional service;
  • Whether the worker supplies his or her own materials and tools;
  • Whether the employer decides how the work must be completed.

Fortunately, even when an employee does not receive a regular wage, he or she may still qualify as a covered employee. For example, elected officials, volunteers, and temporary workers are all considered covered employees for purposes of collecting workers’ compensation.

Who is Not Eligible to Receive Benefits?

Aside from independent contractors, Georgia law also exempts a number of employees from workers’ compensation coverage, including:

  • Federal employees;
  • Railroad employees;
  • Farmers;
  • Domestic workers;
  • Licensed real estate salespeople; and
  • Sports officials, including umpires and referees, unless they are employed by an organization that sponsors sports events.

However, just because an occupation is not specifically covered under state law, does not mean that workers are barred from recovery after a workplace injury, as many employers voluntarily choose to provide workers’ compensation for their employees. Further, some occupations are covered by their own compensation programs. Federal employees, for example, can receive medical benefits and wage replacement under the Federal Employees’ Compensation Act.

What Benefits can an Injured Employee Receive?

Under Georgia’s workers’ compensation laws, injured employees have the right to receive medical, income, and rehabilitation benefits. This means that injured workers can receive compensation for doctor and hospital bills, as well as rehabilitation costs, medications, and physical therapy. In addition to these costs, injured employees can also receive weekly income benefits in an amount that is equal to two-thirds of their average weekly wage. For injuries that are not totally disabling, employees can collect these benefits for up to 400 weeks. Finally, employees who sustain catastrophic injuries at work have the right to collect vocational rehabilitation benefits, which involves strengthening an employee’s work skills. Typical vocational rehabilitation includes:

  • On the job training;
  • Job application and resume services;
  • Educational programs;
  • Interview coaching;
  • Career counseling; and
  • Education and tuition payments.

This type of training can be crucial to helping injured workers learn new skills, while also enabling them to find new employment.

What Should I do if My Claim is Denied?

Unfortunately, hundreds of valid workers’ compensation claims are denied every year, often as a result of one of the following:

  • A failure to file a claim within a month of sustaining an injury;
  • A failure to submit the necessary paperwork;
  • A failure to prove that an injury occurred during the course of employment;
  • The employer disputes the claim; or
  • The State Board of Workers’ Compensation (SBWC) decided that the claimant’s injury was not severe enough to justify benefits.

Claimants whose claims have been denied have the right to appeal the decision by requesting a hearing or mediation with the SBWC. If mediation is unsuccessful, the SBWC will schedule a formal hearing, where the SBWC will hear evidence concerning the claimant’s injury. This requires the submission of medical records and written briefs, as well as expert and eyewitness testimony. If, after review, a judge denies the appeal, the claimant has 20 days to file another appeal with the Appellate Division.

The Appellate Division usually decides cases based on written arguments, and in some situations, oral arguments. However, no new evidence can be submitted at this time. Those whose claims are denied a third time can file an appeal with a state court, although these courts usually defer to the Appellate Division’s decision unless there is clear evidence of error.

How Long Will I Receive Benefits?

Injured employees who sustained non-catastrophic injuries on the job can collect benefits for up to 400 weeks. Those whose injuries qualify as catastrophic, however, may be eligible to collect benefits for the rest of their lives. Finally, even when injured workers return to work, they could still continue to receive benefits if they have been forced to accept lower paying employment as a result of their injuries. Injured workers will be eligible to receive these reduced benefits for up to 350 weeks.

Call Today to Schedule a Free Case Evaluation With a Workers’ Compensation Attorney in Forsyth County

If you were hurt at work and need help navigating the state’s complex workers’ compensation laws, please contact a member of the legal team at the Spillers Law Firm by calling (678) 208-0800 and setting up a free strategy session with an experienced Forsyth County workers’ compensation lawyer.

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